背景:由于镇痛不足或副作用,多达44%的癌症相关疼痛患者需要阿片类药物旋转(OR)。关于轮换使用美沙酮的最有效方法尚无共识。
目的:定义关于轮换使用美沙酮的方法的可用证据,并确定是否存在关于一种方法的优越性的足够证据。
方法:预定义的搜索策略,使用医疗主题词(MeSH)搜索词和使用布尔运算符组合的关键词,已执行。根据系统评价和Meta分析指导的首选报告项目进行研究选择。数据被提取,评估的研究质量,并进行了叙事综合。
结果:共确定了3214项潜在相关研究。包括25项研究:15项回顾性研究和10项前瞻性研究(n=1229)。一项试验比较了三天转换(3DS)和快速转换(RC)方法;二,3DS;10,RC;9,任意(AL)。成功率如下:3DS-93%,RC-71.7%,AL-92.8%。单临床试验和回顾性研究表明,与3DS组(无严重AE)相比,RC组(5例由于AE而退出)的镇痛效果较差,不良事件(AE)过多。稳定镇痛时间如下:RC<4.3天,AL<6天。
结论:确定的证据主要来自不受控制的观察性研究,使因果关系难以确立。研究在方法和结果测量方面存在差异。使用RC方法有过量AE的趋势,与AL和3DS方法相比。AL研究的方法学质量较低。AL和3DS方法的直接比较将是有益的。
BACKGROUND: Up to 44% of patients with cancer-related pain require opioid rotation (OR) because of inadequate analgesia or side effects. No consensus exists regarding the most efficacious method for rotation to methadone.
OBJECTIVE: To define the available evidence regarding methods of rotation to methadone and to determine if sufficient evidence exists regarding the superiority of one method.
METHODS: A predefined search strategy, using Medical Subject Headings (MeSH) search terms and keywords combined using Boolean operators, was performed. Study selection was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Data were extracted, quality of studies assessed, and narrative synthesis undertaken.
RESULTS: A total of 3214 potentially relevant studies were identified. Twenty-five studies were included: 15 retrospective and 10 prospective (n = 1229). One trial compared three-day switch (3DS) and rapid conversion (RC) methods; two, 3DS; 10, RC; nine, ad libitum (AL). Success rates were as follows: 3DS-93%, RC-71.7%, and AL-92.8%. The single clinical trial and retrospective studies demonstrated poorer analgesia and an excess of adverse events (AEs) in the RC group (five dropouts because of AEs) compared with the 3DS group (no severe AEs). Time to stable analgesia was as follows: RC <4.3 days and AL <6 days.
CONCLUSIONS: Evidence identified was mainly from uncontrolled observational studies, making causality difficult to establish. Studies were heterogeneous in methodology and outcome measures. There was a trend toward excess AEs using the RC method, in comparison to the AL and 3DS methods. The methodological quality of the AL studies was low. A direct comparison of AL and 3DS methods would be informative.